Walter et al evaluated patients with early-onset pneumonia following an acute stroke (stroke-associated pneumonia). They gave criteria for a patient’s response to initial antibiotic therapy. The authors are from the University of Rostock in Germany.


Patient selection: acute stroke with early-onset acute pneumonia (within 72 hours of admission)


A patient with pneumonia would be expected to have:

(1) an elevated serum C-reactive protein (CRP), with normal < 10 mg/L

(2) elevated body temperature (varies but often > 38.3° C)


Therapy consisted of intravenous ceftriaxone (2 g per day) and intravenous metronidazole (1.5 g per day). This was intended to cover aerobic and anaerobic bacteria with or without aspiration.


Criteria for response:

(1) >= 50% reduction from maximum C-reactive protein within 7 days

(2) normalization of body temperature


Differential diagnosis of non-response to antibiotic therapy:

(1) aspiration of gastric acid

(2) fungal infection

(3) resistant bacteria


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